,i #aaith ,,congress #ast ,session ,h4 ,r4 #cbje ,,in ,,the ,,house ,,of ,,representatives ,may #e1 #bjbe ,ms4 ,tenney 7for herself and ,mr4 ,crenshaw7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to deny tax deductions and other ,federal funding for the costs of gender transition procedures4 #a4 ,short title ,this ,act may be cited as the ,no ,subsidies for ,gender ,transition ,procedures ,act4 #b4 ,denial of medical expense tax deduction 7a7 ,in general ,subsection 7d7 of section #bac of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new paragraph3 7#ab7 ,expenses relating to gender transition 7,a7 ,in general ,the term medical care does not include any gender transition procedure4 7,b7 ,definitions ,for purposes of this paragraph-- 7i7 ,gender transition procedure 7,i7 ,in general ,the term gender transition procedure means any hormonal or surgical intervention for the purpose of gender transition1 including-- 7aa7 the provision of gonadotropin-releasing hormone agonists or other puberty-suppression drugs or puberty-blocking drugs to stop or delay normally-timed puberty in an individual who does not identify as his or her sex1 7bb7 the provision of testosterone1 estrogen1 progesterone1 or other androgen blockers to an individual at doses which are supraphysiologic to what would normally be produced endogenously in a healthy individual of the same age and sex1 with the intent to align an individual's physical appearance with an identity that differs from his or her sex1 7cc7 surgical procedures that attempt to transform an individual's physical appearance to align with an identity that differs from his or her sex or that attempt to alter or remove an individual's sexual organs to minimize or destroy their natural biological functions1 7dd7 castration1 vasectomy1 penectomy1 orchiectomy1 vaginoplasty1 clitoroplasty1 vulvoplasty1 mastectomy1 hysterectomy1 oophorectomy1 ovariectomy1 reconstruction of the fixed part of the urethra with or without metoidioplasty or phalloplasty1 metoidioplasty1 phalloplasty1 vaginectomy1 scrotoplasty1 implantation of erection or testicular prostheses1 reduction thyrochondroplasty1 chondrolaryngoplasty1 tubal ligation1 sterilization1 augmentation mammoplasty1 placement of chest implants to create feminine breasts1 placement of fat or artificial implants in the gluteal region1 liposuction1 lipofilling1 voice surgery1 hair reconstruction1 pectoral implants1 any plastic1 cosmetic1 or aesthetic surgery which feminizes or masculinizes the facial or other physiological features of an individual1 and any removal of any otherwise healthy or non-diseased body part or tissue4 7,,ii7 ,exclusions ,the term gender transition procedure does not include1 when furnished to an individual by a health care provider with the consent of such individual 7or1 if applicable1 such individual's parents or legal guardian7-- 7aa7 services to individuals born with a medically verifiable disorder of sex development1 including an individual with external sex characteristics which are irresolvably ambiguous1 such as an individual born with #df ,,xx chromosomes with virilization1 an individual born with #df ,,xy chromosomes with undervirilization1 or an individual born having both ovarian and testicular tissue1 7bb7 services relating to any other physician-diagnosed disorder of sexual development with respect to which the physician has determined through genetic or biochemical testing that the individual does not have normal sex chromosome structure1 sex steroid hormone production1 or sex steroid hormone action for a healthy male or female of the same age1 7cc7 the treatment of any infection1 injury1 disease1 or disorder caused or exacerbated by the performance of gender transition procedures1 without regard to whether the gender transition procedure was performed in accordance with ,state and ,federal law or whether the gender transition procedure is treated as medical care under this section1 7dd7 any procedure undertaken because the individual suffers from a physical disorder1 physical injury1 or physical illness 7but not mental1 behavioral1 or emotional distress or a mental1 behavioral1 or emotional disorder7 which would1 as certified by a physician1 place the individual in imminent danger of death or impairment of major bodily function unless the procedure is performed to alleviate said physical disorder1 physical injury1 or physical illness1 7ee7 procedures to restore or reconstruct the body of the individual in order to correspond to the individual's sex after one or more previous gender transition procedures1 which may include the removal of a pseudo phallus or breast augmentation1 7ff7 puberty suppression or puberty-blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty1 or 7gg7 male circumcision4 7ii7 ,gender transition ,the term gender transition means the process by which an individual goes from identifying with or presenting as his or her sex to identifying with or presenting as a self-proclaimed identity which does not correspond with or is different from his or her sex1 and may be accompanied by social1 legal1 or physical changes4 7iii7 ,sex ,the term sex1 when referring to an individual's sex1 means either male or female1 as biologically determined4 7iv7 ,female ,the term female1 when used to refer to a natural person1 means a person belonging1 at conception1 to the sex characterized by a reproductive system with the biological function of producing eggs 7ova74 7v7 ,male ,the term male1 when used to refer to a natural person1 means a person belonging1 at conception1 to the biological sex characterized by a reproductive system with the biological function of producing sperm4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #c4 ,prohibiting ,federal medicaid funding for gender transition procedures 7a7 ,in general ,section #aijc7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7i77 is amended-- 7#a7 in paragraph 7#bf71 by striking 2 or and inserting a semicolon2 7#b7 in paragraph 7#bg71 by striking the period at the end and inserting 2 or2 7#c7 by inserting after paragraph 7#bg7 the following new paragraph3 7#bh7 with respect to any amounts expended for any specified gender transition procedure 7as defined in section #aije7kk77 to an individual enrolled in a ,state plan under this title 7or a waiver of such plan71 including any amounts expended for the administration of a ,state program that furnishes any such procedure4 2 and 7#d7 in the flush left matter at the end1 by striking and 7#ah71 and inserting 7#ah71 and 7#bh74 7b7 ,prohibiting ,federal medicaid funding for gender transition procedures ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended by adding at the end the following new subsection3 7kk7 ,prohibiting ,federal medicaid funding for specified gender transition procedures 7#a7 ,specified gender transition procedures defined ,for purposes of section #aijc7;i77#bh71 except as provided in paragraph 7#b71 the term specified gender transition procedure means1 with respect to an individual1 any hormonal or surgical intervention for the purpose of gender transition1 including-- 7,a7 the provision of gonadotropin-releasing hormone agonists or other puberty suppression drugs or puberty-blocking drugs to stop or delay normally timed puberty in an individual who does not identify as his or her sex2 7,b7 the provision of testosterone1 estrogen1 progesterone1 or other androgen blockers to an individual at doses which are supraphysiologic to what would normally be produced endogenously in a healthy individual of the same age and sex1 with the intent to align an individual's physical appearance with an identity that differs from his or her sex2 7,c7 surgical procedures that attempt to transform an individual's physical appearance to align with an identity that differs from his or her sex or that attempt to alter or remove an individual's sexual organs to minimize or destroy their natural biological functions2 or 7,d7 castration1 vasectomy1 penectomy1 orchiectomy1 vaginoplasty1 clitoroplasty1 vulvoplasty1 mastectomy1 hysterectomy1 oophorectomy1 ovariectomy1 reconstruction of the fixed part of the urethra with or without metoidioplasty or phalloplasty1 metoidioplasty1 phalloplasty1 vaginectomy1 scrotoplasty1 implantation of erection or testicular prostheses1 reduction thyrochondroplasty1 chondrolaryngoplasty1 tubal ligation1 sterilization1 augmentation mammoplasty1 placement of chest implants to create feminine breasts1 placement of fat or artificial implants in the gluteal region1 liposuction1 lipofilling1 voice surgery1 hair reconstruction1 pectoral implants1 any plastic1 cosmetic1 or aesthetic surgery which feminizes or masculinizes the facial or other physiological features of an individual1 and any removal of any otherwise healthy or non-diseased body part or tissue4 7#b7 ,exclusions ,the term specified gender transition procedure shall not include1 when furnished to an individual by a health care provider with the consent of such individual 7or1 if applicable1 the parents or legal guardian of such individual7-- 7,a7 services to individuals born with a medically verifiable disorder of sex development1 including an individual with external sex characteristics which are irresolvably ambiguous1 such as an individual born with #df ,,xx chromosomes with virilization1 an individual born with #df ,,xy chromosomes with undervirilization1 or an individual born having both ovarian and testicular tissue2 7,b7 services relating to any other physician-diagnosed disorder of sexual development with respect to which the physician has determined through genetic or biochemical testing that the individual does not have normal sex chromosome structure1 sex steroid hormone production1 or sex steroid hormone action for a healthy male or female of the same age2 7,c7 the treatment of any infection1 injury1 disease1 or disorder caused or exacerbated by the performance of gender transition procedures1 without regard to whether the gender transition procedure was performed in accordance with ,state and ,federal law or whether the gender transition procedure is treated as medical care under this section2 7,d7 any procedure undertaken because the individual suffers from a physical disorder1 physical injury1 or physical illness 7but not mental1 behavioral1 or emotional distress or a mental1 behavioral1 or emotional disorder7 which would1 as certified by a physician1 place the individual in imminent danger of death or impairment of major bodily function unless the procedure is performed to alleviate said physical disorder1 physical injury1 or physical illness2 7,e7 any procedure to restore or reconstruct the body of the individual in order to correspond to the individual's sex after #a or more previous gender transition procedures1 which may include the removal of a pseudo phallus or breast augmentation2 7,f7 puberty suppression or puberty-blocking prescription drugs for the purpose of normalizing puberty for an individual experiencing precocious puberty2 or 7,g7 male circumcision4 7#c7 ,additional definitions ,for purposes of this subsection3 7,a7 ,gender transition ,the term gender transition means the process by which an individual goes from identifying with or presenting as his or her sex to identifying with or presenting as a self-proclaimed identity which does not correspond with or is different from his or her sex1 and may be accompanied by social1 legal1 or physical changes4 7,b7 ,sex ,the term sex1 when referring to an individual's sex1 means either male or female1 as biologically determined1 including as described in subparagraphs 7,c7 and 7,d74 7,c7 ,female ,the term female1 when used to refer to a natural person1 means an individual belonging1 at conception1 to the sex characterized by a reproductive system with the biological function of producing eggs 7ova74 7,d7 ,male ,the term male1 when used to refer to a natural person1 means an individual belonging1 at conception1 to the biological sex characterized by a reproductive system with the biological function of producing sperm4 4 7c7 ,effective date ,the amendments made by this section shall apply to services furnished on or after the date of the enactment of this ,act4 #d4 ,prohibiting ,federal children's health insurance program funding for gender transition procedures on minors 7a7 ,in general ,section #baje7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77 is amended by adding at the end the following new paragraph3 7#ac7 ,limitation on payment for specified gender transition procedures for minors ,payment shall not be made to a ,state under this section for any amount expended under the ,state plan to pay for specified gender transition procedures 7as defined in section #aije7kk77 or to assist in the purchase1 in whole or in part1 of health benefit coverage that includes coverage of any such procedure4 4 7b7 ,conforming amendment ,section #bajg7;e77#a77,n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77,n77 is amended by striking and 7#ag7 and inserting 7#ag71 and 7#bh74 7c7 ,effective date ,the amendments made by this section shall apply to services furnished on or after the date of the enactment of this ,act4 #e4 ,prohibiting ,federal medicare funding for gender transition procedures 7a7 ,in general ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77 is amended-- 7#a7 in paragraph 7#bd71 by striking or at the end2 7#b7 in paragraph 7#be71 by striking the period at the end and inserting 2 or2 and 7#c7 by inserting after paragraph 7#be7 the following new paragraph3 7#bf7 which are specified gender transition procedures 7as defined in section #aije7kk774 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply to items and services furnished on or after the date of the enactment of this ,act4 #f4 ,exclusion of gender transition procedures from essential health benefits ,section #acjb7;b77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77#b77 is amended-- 7#a7 in the paragraph heading1 by striking ,limitation and inserting ,limitations2 7#b7 by redesignating subparagraph 7,b7 as subparagraph 7,c72 7#c7 by inserting after subparagraph 7,a7 the following3 7,b7 ,exclusions ,in defining the essential health benefits under paragraph 7#a71 or in revising essential health benefits under paragraph 7#d77;,h71 the ,secretary shall not include the category of gender transition procedures 7as defined in section #bac7;d77#ab77;,b7 of the ,internal ,revenue ,code of #aihf7 or any items or services covered within such a category4 2 and 7#d7 in subparagraph 7,c7 7as so redesignated71 by striking paragraph 7#b7 and inserting subparagraph 7,a74